Mission Mondays Registration/Medical/Waiver 2026

Mission Mondays Registration, Emergency Medical, and Waivers - 2026

Sponsored by SS. Cosmas & Damian Parish, Our Lady of Guadalupe, Church of the Resurrection, St. Rita
Participant Name:*
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Participant Cell Phone
Participant Email
Home Parish*

Ss. Cosmas and DamianOur Lady of GuadalupeChurch of the ResurrectionSt. RitaHoly AngelsOther
School for 2026-2027 School Year*
Grade Level for 2026-2027 School Year*
T-Shirt Size*
Do you have any gifts or talents you may want to share? (Musician, lector, cantor, anything!)
Parent/Guardian Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Doctor:*
Phone Number*

Area CodePhone Number
Hospital preference:
Phone Number

Area CodePhone Number
Name of Dentist:
Phone Number

Area CodePhone Number
To avoid any adverse drug reaction during an emergency, please list medications you are taking:
Do any medications need to be administered during Mission Mondays?*

YesNo
If medications need to be administered during Mission Mondays, please provide names and instructions here:
Allergies:
Dietary Restrictions
List any medical conditions our staff needs to be aware of:
Emergency Contacts
(1) Name:*
Relationship:*
Cell Phone*

Area CodePhone Number
Home Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(2) Name:
Relationship:
Cell Phone

Area CodePhone Number
Home Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Camp Information
- All Mission Mondays events will take place at Ss. Cosmas and Damian parish located at 10419 Ravenna Rd., Twinsburg.
- Our Mystery Night Kickoff Event will take place on Sunday, June 7 from 5:00 pm - 8:00 pm. There is no charge for this event and dinner will be provided.
- Our service days will be June 8, 15, and 22.
- The cost is $50 for one day, $90 for two days, or $120 for three days. This cost includes dinner and snacks each day, a Mission Mondays t-shirt, transportation to service sites, and all materials needed throughout the day.
Please select each of the camp dates you will be attending:*

June 7 (kickoff event, there is no charge for this event, just used for planning purposes)June 8June 15June 22
As parent/legal guardian of the child listed above, I hereby grant permission to Mission Mondays. to use the child’s photographs and recordings containing his or her image, likeness, or voice on its website or in other official church websites, social media, printed publications, video recordings, and television or motion picture productions that will be produced, used, or distributed for legitimate purposes and without further consideration.*

YesNo
By signing below, I attest that all information above is true and accurate, to the best of my knowledge. I also agree to the above permissions and releases, and that I am a legal parent/guardian of the participant.

Additionally, you agree that you are the parent or legal guardian of the above-named camper, and are over the age of 18. I certify that my child has my permission to attend camp and participate in all activities, and may be transported to service sites by the Mission Mondays chaperones. I authorize the Mission Mondays participating parishes to use my camper's picture, testimony, and video in any promotional material(web, print, or media). My child may receive any e-mails from the camp.
Signature of Parent/Legal Guardian (if participant is a minor)*
Name of Signer *

First NameLast Name
Payment Information

Cost for camp is $50 for one day, $90 for two days, and $120 for three days.
Payments may be made by check, made out to Ss. Cosmas and Damian Parish. They may be submitted to your parish youth minister, dropped off at Ss. Cosmas and Damian Parish Office, or mailed to:

Ss. Cosmas and Damian Parish
Attn: Keri Knowles
10419 Ravenna Rd.
Twinsburg, OH 44087

Electronic payments may also be made on this form. Electronic payments will incur a $3.00 service fee.

If paying with a check, please scroll to the bottom of the page and press the 'Submit' button.
Will you be paying electronically, or by check?*

ElectronicallyCheck
My Products
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One Day$53.00

Two Days$93.00

Three Days$123.00

Total $0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
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Mission Mondays Registration, Emergency Medical, and Waivers - 2026

Emergency Contacts